By Dr. Joseph E. Marine
Accepting physician-assisted suicide is a slippery slope. The American Medical Association believes it is wrong for doctors to kill. Let’s stick by that belief.
The American Medical Association House of Delegates in Chicago will soon engage in a critical debate over the report of the AMA’s Council on Ethical and Judicial Affairs concerning the practice of assisted suicide. For almost 30 years, pro-assisted suicide organizations have been lobbying for legalized assisted suicide throughout the USA. This practice involves a physician prescribing a non-FDA approved lethal overdose of drugs to a person believed to have a terminal illness.
In 2016, the AMA charged the CEJA with reevaluating the AMA’s ethical position, issued in 1994, in opposition to the legalization and practice of assisted suicide. The current AMA position states that assisted suicide “is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.”
In its May report, after two years of exhaustive study, having considered published literature and written and oral testimony from many participants on all sides of the debate, CEJA concluded that no change in the AMA’s ethical code or language used to describe assisted suicide is warranted.
The CEJA should be applauded for the thoroughness and sensitivity with which it has approached its difficult task. The report maintains alignment of the AMA’s position against assisted suicide with that of the American College of Physicians, the American Nurses Association and a medical-ethical tradition that extends back more than 2,000 years. The CEJA report recognizes the simple fact that assisted suicide is not medical care. It has no basis in medical science, medical tradition or evidence-based medicine.
The incompatibility of physician-assisted suicide with ethical medical practice is illustrated by the stunning news published in April that in Washington, D.C., nearly a year after enactment of assisted-suicide law, only two out of 11,000 licensed physicians (0.02%) had registered to participate. The indisputable facts emerging from Washington show physicians still recognize that assisted suicide is gravely problematic, and that physicians who practice physician-assisted suicide may not be trusted by patients with their lives and their health.
The supposed “safeguards” in assisted suicide laws enacted in America are an illusion. They include no requirement for psychiatric evaluation, for witnesses to the consumption of the lethal overdose, no medical examiner inquests, no independent safety monitoring board and no mandatory routine audits of records and documentation. There is no requirement that the prescribing physician have a meaningful long-term patient-physician relationship with the patient seeking assisted suicide and physicians are immunized from ordinary negligence.
Additionally, all medical records and documents connected to the provision of assisted suicide are protected from legal discovery or subpoena, ensuring that no investigation is ever likely to take place.
Additionally, once the fallacy is accepted that ending life by assisted suicide is a “compassionate” form of “medical care” and is a “right,” this false principle will inevitably be extended to others, as it has been in the Netherlands, Belgium and now Canada. In the Netherlands and Belgium, patients with serious illnesses, whether “terminal” or not, can request euthanasia for almost any reason. Incredibly, some patients in these countries are actually euthanized solely because of mental illness.
Here in the states, there are people like Michael Freeland, who had a 40-year history of depression and suicidal ideation, receiving a lethal prescription. Kate Cheney, a diagnosed dementia patient, was prescribed assisted suicide after being denied a number of times, because her family shopped for a doctor until they found one who would write the script. Where does it end?
Assisted suicide will affect everyone. Proponents of assisted suicide assert that it is a matter of personal choice, and that participation will be required of no one. This is a naive viewpoint.
Assisted suicide will inevitably color doctors’ view of care toward patients with advanced illness, advanced age and disabilities. With time, the “choice” may become a societal expectation, especially under the economic pressure of rising health care costs.
As Derek Humphry, the founder of the modern euthanasia movement, wrote in “Freedom to Die”: “In the final analysis, economics, not the quest for broadened individual liberties or increased autonomy, will drive assisted suicide to the plateau of acceptable practice.”
Assisted suicide is dangerous, is unnecessary and will permanently damage the integrity of and public trust in the health professions and the health care system. The AMA House of Delegates should strongly support adoption of the CEJA report and maintain its ethical position against physician-assisted suicide.
Dr. Joseph E. Marine is a member of the American Medical Association and an associate professor of medicine at Johns Hopkins University.
Source: “Physician-assisted suicide isn’t right for doctors. Don’t change the AMA’s position.“, USA Today